Neighborhood Organization for Pediatric Asthma Management in the Neighborhood Asthma Coalition: Discussion and Conclusions
Concurrently, the National Inner City Cooperative Asthma Study sponsored by the National Institute of Allergy and Immunologic Disease is about to launch demonstration projects reflecting similar themes of integration and promotion of care at the community as well as the individual level.
Parallels between the problems of asthma care in the United States and in New Zealand, noted above, support the generality of the links among economic poverty, minority status, barriers to care, and morbidity and mortality. More promising is the parallel in responses to these problems. Asthma medications inhalers other As described elsewhere in this issue, the New Zealand response to asthma has included a range of public education campaigns, hospital-based multidisciplinary asthma centers, and trained educators from among nurses and other professionals who extend care through cooperation with other agencies, training clinic workers, and follow-up in their communities of patients initially contacted through emergency visits. In a socioeconomically disadvantaged area, the New Zealand campaign has established a “free, accessible, culturally-appropriate, community-based education center staffed by health workers representing the predominant ethnic groups. The impacts of this community-based center have been demonstrated on patient knowledge and self management skills and reports of symptoms, but, after 9 months, not yet on measures of morbidity or utilization of hospital care.
The experience in the United States as well as that in New Zealand, and no doubt, other countries supports an important observation about asthma care. Although its history is complicated by misplaced emphasis on asthma as psychological in its etiology, recent studies have clearly implicated the role of psychological, social, economic, and indeed, political factors in its care and course and in adjustment to it. Current work extends this perspective in showing the importance not only of the clinical care provided by the professional to the individual patient, but of the access to that care, the education of the patient as well as family and neighbors, and to these ends, the understanding of asthma by the larger community. Among the important efforts to demonstrate and evaluate integration of clinical and community asthma care, the Neighborhood Asthma Coalition illustrates the potential of community organization approaches to involve neighborhood residents in planning and implementing programs for asthma education and management; to generate promotional activities directed toward the general public to increase understanding of asthma and its treatment; and to instigate education and support for asthma management provided by trained neighborhood residents. Such approaches may help reduce the excess disease burden of asthma among socioeconomically distressed groups. They may also signal important dimensions of asthma care and chronic disease care in general as the burdens of chronic disease extend to greater portions of our populations, as medical innovations in chronic disease care place greater importance on the daily management of such care by the individual, and as pressures on the services offered by health-care systems continue to rise.